All Wales Ovarian Cancer Prehabilitation Project (AWOCPP).

Abstract

Over 50% of patients with ovarian cancer are diagnosed with advanced disease (stage 3+) in Wales when treatment typically involves chemotherapy, combined with cytoreductive surgery. Postoperative morbidity is common resulting in prolonged hospital stays and delays in returning to chemotherapy. Patients with advanced ovarian cancer commonly have modifiable risk factors that can be targeted for improvement with personalised prehabilitation. Multimodal personalised prehabilitation has been shown to have a positive impact on perioperative outcomes and length of stay (LOS).Quality improvement methods were used to implement a multimodal prehabilitation programme for all patients with advanced ovarian cancer planned for surgery in Wales. A unique approach to determining an individual patient's modifiable risk factors was devised that enabled a personalised prehabilitation programme to be created including exercise, smoking cessation, medical and nutritional optimisation and emotional support. Data were collected to enable future health economic evaluation of the programme in anticipation of national role out as standard of care. To evaluate if the prehabilitation intervention was impacting the quality of care, the following outcome measures were assessed: LOS, postoperative complications and surgery to chemotherapy interval (SCI). These measures were compared with a historical Welsh data set from 2018 to 2019 when access to prehabilitation was not available.Following the implementation of prehabilitation for ovarian cancer, the median LOS reduced from 6 to 5 days (p=0.29). There was a reduction in postoperative complications: from 16.9% to 12.7% (Grade 2), 4.4% to 1.8% (Grade 3), 0.6% to 0% (Grade 4+5). The median SCI following prehabilitation was 43.5 days (range 27-91) compared with 40 days (range 15-182 (p=0.65)).Prehabilitation has had a positive impact on the treatment pathways for advanced ovarian cancer in Wales. Means of improving patient engagement and establishing cost-effective delivery need to be developed to make this intervention standard of care.